Provider Demographics
NPI:1235318098
Name:PRAIRIE LAKES THERAPIES, INC.
Entity type:Organization
Organization Name:PRAIRIE LAKES THERAPIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LOHN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:320-231-1114
Mailing Address - Street 1:2182 66TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-9127
Mailing Address - Country:US
Mailing Address - Phone:320-231-1114
Mailing Address - Fax:
Practice Address - Street 1:2182 66TH AVE NE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-9127
Practice Address - Country:US
Practice Address - Phone:320-231-1114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty